Pyriform Augmentation as an Ancillary Procedure in Facial Rejuvenation Surgery

Abstract

A patient is presented in whom augmentation of the pyriform aperture of the maxilla was performed with porous hydroxyapatite in concert with a face and brow lift. Basic research has recently shown that remodeling of the facial skeleton continues throughout life and that this remodeling process leads to changes in the position of several key areas. The pyriform aperture was identified as one region that remodels in a posterior direction, leading to retrusion of the alar base in the older individual. This skeletal retrusion occurs in a very site-specific fashion, and its effects are reflected on the overlying soft tissues of the face. With aging, remodeling of the pyriform aperture posteriorly causes the alar base to appear recessed and decreases the nasolabial angle, changes that are noted on the profile of the older individual. Augmentation of the pyriform aperture can be achieved through a buccal sulcus incision and, when used in conjunction with standard facial rejuvenation procedures, can improve the overall result in facial cosmetic surgery.

Individuals With a Long Face Growth Pattern and Excess Inferior Scleral Exposure: Is There Improvement After Maxillary (Le Fort I) Advancement and Vertical Shortening?

“…17 A critical review of the literature provides little convincing evidence to support the theory put forth by Pessa and colleagues regarding a "progressive deterioration or resorption of the infraorbital rim, zygoma or the anterior maxilla with aging" in humans. [11][12][13][14][15][16] Our study confirms the clinical observation of a negative vector relationship in a subgroup of individuals with a developmental dentofacial deformity characterized as a Long Face growth pattern.…”

“…They also believe that, with age, the upper aspect of the anterior maxilla undergoes partial reabsorption with progressive distortion (i.e., concavity). [11][12][13][14][15][16] We believe that maxillary horizontal (sagittal) deficiency that has been present since the teenage years, rather than age induced skeletal atrophy, is a frequent cause of the observed negative vector which results in the unfavorable midface and lower eyelid appearance that only worsens with age. 17 A critical review of the literature provides little convincing evidence to support the theory put forth by Pessa and colleagues regarding a "progressive deterioration or resorption of the infraorbital rim, zygoma or the anterior maxilla with aging" in humans.…”

“…1,4 Pessa and colleagues agree with Jelks and believe that skeletal deficiency is, in many cases, responsible for the negative vector relationship seen in adults with unattractive periorbital aging. 1,4,[11][12][13][14][15][16] Pessa goes on to postulate that, with age, the infraorbital rims partially resorb and regress posterior relative to the cornea. They also believe that, with age, the upper aspect of the anterior maxilla undergoes partial reabsorption with progressive distortion (i.e., concavity).…”

ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications

“…Certain patients may develop a depression or hollowing of the cheeks in front of the canine fossa [16] or in the submalar region. This circumscribed atrophy of the malar fat pad and adjacent subcutaneous fat is pronounced in patients with facial lipodystrophy who are on HIV medication [17, 18].…”

Frequently Used Grafts in Rhinoplasty: Nomenclature and Analysis

“…Lateral crural strut graft.Plastic and Reconstructive Surgery • July 2006 26e grafts, hydroxyapatite granules or other alloplastic implants are preferred by others 27. …”